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Pressured to never show weakness, athletes struggling with mental health issues have long suffered in silence or risked stigmatization for speaking out. Meet the Canadian academics working to change all that.

Krista Van Slingerland has been thinking about suicide for months. She even Googled the least painful way to go about it. It’s the summer of 2013 and Van Slingerland, a student at Carleton University, is suffering. She was recently cut from the school’s basketball team, after three mostly successful years, and is battling anxiety and depression, along with a deep sense of emptiness. There’s a crushing weight on her chest and Van Slingerland just can’t envision a way to remove it. She desperately misses basketball and feels she has failed.

Drunk after a night out, she’s returned home to find the place empty, none of her housemates are there. She begins to self-harm, an act that has become increasingly normal for Van Slingerland these past few months. Then she reaches for a crayon and scribbles “I’m sorry” on a piece of paper, a message intended for her family. She texts a friend who is aware of what she’s going through and breaks down sobbing on the kitchen floor. It’s 2 a.m. and she is alone in the dark.

The thought of picking herself up and taking all the pills in the medicine cabinet is swirling in her mind when she hears a knock on the door. It’s the police, responding to a 911 call from the friend Van Slingerland texted. She agrees to let the officers take her to the hospital.

Looking back on that night now, Van Slingerland is troubled by the note she wrote. “I would 100 per cent want to say something to my brothers,” she says. “I was not all there.

“As much as I may have gone through with it,” she adds, “I really just wanted somebody to help me.”

Natalie Durand-Bush is sitting in on a session that her daughter is having with a psychiatrist, because 13-year-old Keana is too young to be doing this by herself. Durand-Bush has her mom hat on, but is also wearing a professional one. As a mental performance consultant herself, she just can’t help it. Overall, the psychiatrist Keana is working with has been great, but Durand-Bush has identified one major gap: The physician just doesn’t understand sports.

Soccer is a major part of life for Keana, an elite player. The sport didn’t cause her recent near suicide attempt. The reason behind that was anxiety and depression, which plague both sides of the family. But Durand-Bush knows, better than most given her work, that when sport is a huge part of who you are as a person and your psychiatrist just doesn’t understand the game, it can be harmful.

As Keana’s mental condition grew worse, soccer was her one respite. It was relief and release. When she was hospitalized following the incident, Keana’s teammates and coaches were among the first to visit her. And as her health began to improve, it was a steady reservoir of positivity that was instrumental in her recovery. “I saw how sport could be part of the solution and was a source of support for people struggling with mental health,” Durand-Bush says. “That was the case for my daughter.”

PART OF THE SOLUTION

Van Sligerland, left, and Durand-Bush founded the Canadian Centre for Mental Health and Sport in 2017

Those experiences were the sparks that set in motion everything Van Slingerland and Durand-Bush are trying to accomplish today. They are co-founders of the Canadian Centre for Mental Health and Sport (CCMHS), a not-for-profit organization supporting competitive and high-performance athletes and coaches. Formed in November 2017, the centre deploys a specialized team of practitioners to work with people in sport who are struggling mentally. “Something has to drive you and it’s really personal for me and for Natalie,” says Van Slingerland. “That’s sort of the fuel behind all this.”

One in five Canadians experience a mental health challenge each year, according to a 2019 study published in the Clinical Journal of Sport Medicine. It would be perfectly average, then, for four athletes on a roster of 20 to find themselves struggling to perform in their sport or with daily tasks. Still, the full scope of what Van Slingerland and Durand-Bush are up against can’t be wholly measured by research and statistics. That’s because athletes have traditionally suffered in silence, leading to a skewed number of reported cases, because despite advances in wider societal conversation around mental health, the stigma is still steadfast throughout sport. For every Michael Phelps, Kevin Love or Robin Lehner who publicly shares their story of mental illness, there are countless others who choose to stay quiet.

“Athletes are revered as gods,” says Durand-Bush. “They are these machines, these resilient, mentally tough machines that can do anything. But oh, guess what? Anecdotally and behind the scenes, we knew that wasn’t the case. If you look at the athletes who have come out to share their stories, most of them are retired, because they didn’t feel safe [opening up during their careers].”

It’s late February and a snowstorm has walloped Ottawa. The House of Sport within the RA Centre — a sprawling multi-sport and recreation facility near the heart of the city — is barren, save for a few employees who made the trek to work in the near-whiteout conditions. Van Slingerland and Durand-Bush are two such people and they’re hunkered down with laptops in their open-concept workspace. The CCMHS is based out of the House of Sport, along with several other organizations that share the 36,000-square foot space, including Hockey Canada, Jumpstart and Commonwealth Sport Canada. “I’ve never seen this place so deserted,” says Durand-Bush.

CCMHS is essentially a side job for the 48-year-old, who is also a sport psychology professor in the School of Human Kinetics at the University of Ottawa and in private practice as a mental performance consultant. The 28-year-old Van Slingerland is a PHD candidate at UOttawa, whose doctoral work involves designing, implementing and evaluating the CCMHS.

The women became acquainted while Van Slingerland completed her master’s; Durand-Bush was her supervisor. Once that was done, and with Van Slingerland mulling pro basketball in Europe, Durand-Bush made a proposal: “I said, ‘It’s always been my dream to open a mental health centre that is specialized for sport,’” she recalls. “‘I think you’d be the perfect candidate to study this.’”

Durand-Bush’s idea for CCMHS sprung from conversations with Goran Kentta, a professor who started a similar centre in Sweden. The two have collaborated for years and Durand-Bush watched keenly as Kentta developed a service that provided direct mental healthcare to athletes and coaches. She invited him to be one of 20 CCMHS stakeholders — people from the sport and mental health communities recruited to offer their thoughts and support. “A centre like that has to be evidence-based. It has to be driven by experts, by facts,” Durand-Bush says. “You don’t just create that from scratch.”

“Athletes are revered as these resilient, mentally tough machines that can do anything. But oh, guess what? Anecdotally and behind the scenes, we knew that wasn’t the case.”

She and Van Slingerland began to design the centre in November 2017, building it around integrated care, research and community engagement. Those pillars, along with collaborative, sport-focused mental health care services for athletes and coaches, have made the not-for-profit the first of its kind in Canada, according to Durand-Bush.

The CCMHS opened its doors to clients in 2018. The centre currently has a care team roster of 17 that includes psychologists, psychotherapists, counsellors, physicians and researchers. They are spread across the country and each has some background in sport. Clients must be at least 16 years old and participating in sports at the provincial, national, international or professional levels. Retired athletes who are transitioning out of competitive sports are also accepted.

When a potential patient reaches out to CCMHS, they first go through an intake appointment with the centre’s care coordinator, Poppy DesClouds. If the client’s needs are a fit for the centre, DesClouds pairs them with a team of two to three CCMHS practitioners. The corresponding sessions can then take place physically at CCMHS, in the Canadian city where an athlete resides, or even remotely, through an online platform.

“One of the strengths of the centre is that it is sports-specific,” says Mike Kostka, a former NHL player who sought help from CCMHS. “In sport, there is a lot of bravado and being afraid of showing weakness as far as getting help goes. But, also, being skeptical. ‘Who’s really going to understand what I’m going through?’

“I felt at ease off the get-go,” adds Kostka, who is based in Ottawa and was virtually paired with a CCMHS team member in Calgary. “As opposed to [going] to a general psychologist or mental performance consultant and you don’t know if they’re going to understand. You don’t want to waste your time. This stuff is important. It matters … the fact that they provide that sports-specific help puts you at ease to start.”

When Kostka decided to hang up his skates in 2018, he was at a crossroads. Following a career that saw him play 85 NHL games split between five organizations, the Toronto native needed to decide what was next. He had earned an undergraduate degree in psychology from the University of Massachusetts Amherst in 2008, before signing in the NHL, so sports psychology seemed like a good direction to take.

He settled on UOttawa, where he is now enrolled in the Master of Human Kinetics program, studying to be a mental performance consultant. The first few weeks of his transition from professional hockey to being a student again brought serious self-reflection. Kostka realized there were some things in his mind that he needed to unpack. “One of the most difficult pieces is establishing a new purpose,” says the 34-year-old.

Kostka’s entire life — motivation, routines, social network — was tied to hockey. “And now that’s gone,” he says. “And you’re kind of floating untethered, looking where to plug in. ‘Okay, I know how to work hard, but I don’t know how to direct it.’ Or, ‘It was physical before and now I have to use my brain in different ways.’”

The move from Toronto to Ottawa didn’t help either. In the NHL or AHL, when he arrived in a new city at the outset of a season, he’d have 22 instant friends in the locker room, people to bond and build camaraderie with. Contributing to that group was built into his identity. “My entire life, I worked toward one goal,” says Kostka. “I knew what it was — I wanted to get to the NHL or play at the highest level possible — and everything you do is surrounded by that as your identity. As you transition out, some of those pieces start getting chipped away and you have to question a little bit deeper and ask yourself, ‘Without this as part of my identity, who am I?’”

BREAKTHROUGHS OF THE GAME

Small details in the physical space itself speak to the way sport is integrated into the DNA of the CCMHS

Kostka uses an analogy to describe how CCMHS helped him. “We were given a hammer,” he says of his time in hockey. “We had that one tool and we used it for everything we did. We just hammered away and just pounded. And so, when it came to, say, performance anxiety, what do you do? You plow through. That’s what we knew. That’s the one tool we had in our tool kit. The great thing about this centre and what these practitioners can really help with is building up that tool box for athletes to go, ‘Oh, I have a wrench, I can use that to loosen the tension.’”

He says the care he received from CCMHS over the course of a few months played an important role in helping him find his footing. That type of aid would have benefited Ben Meisner during his time in the ECHL. The goalie, who detailed his near suicide attempt in a 2018 article in The Players’ Tribune, sought professional help when he was suffering from anxiety, depression and obsessive-compulsive disorder, but was impeded by the logistics of life in the minors.

After feeling that he’d made progress in his first session, Meisner was called up to the AHL and could not see the therapist again until he was sent back down. He did that, but before he could go a third time, he was reassigned to a completely different city. The Halifax native is familiar with the CCMHS now and says its ability to offer online, specialized help to athletes would have been beneficial to him back then. “It would have been unbelievable because no matter where I was in North America, I would have known that I could have had regular services and could have had a support system that would have had my back wherever I went,” says Meisner, 29. “That’s huge for a lot of athletes because you look at guys who play on ECHL contracts every year, it’s not abnormal to play on three, four, five different teams. A lot of the time, the whole seeing someone in person, it’s such a, ‘Why do I bother?’ Because you never know if you’re going to be there for two days, two weeks, two months.”

Getting to a point where you receive a diagnosis and begin learning methods to help combat your issues takes time and several appointments, notes Meisner. It also requires effort on your part, because there is pain associated with bringing up difficult aspects of your life. That’s why switching to a different mental health professional in a different city can seem unreasonable and unappealing. “You have to uncover a lot of things you don’t want to uncover. A person like me — I dug a hole for 20 years. It takes a lot of dirt to fill that hole back in and when you just keep taking a spoon to try and do it and start over all the time, it’s discouraging.”

“People don’t like to admit weakness, especially when it’s in their mind. It’s much easier for some people when they can point to a broken leg or something physically wrong.”

Meisner, who currently patrols the crease for EHC Freiburg in the German league’s second division, is coming off the best season of his professional career and was recently named the league’s goalie of the year. His current club employs a psychologist who is accessible to players at any time and while he would not hesitate to seek help within his own organization, Meisner believes that’s not the case for everyone.

“There are other people who would much rather tackle it on their own,” he says. “Because as much as [teams] always say, ‘things stay between us,’ all it takes is for you to be chatting to the [psychologist] in front of the coffee machine in the locker-room and the coach to walk by and all of a sudden that little seed is there: Ben’s been playing bad. He’s been kind of quiet. Now, here he is chatting with the psychologist. I’ve never seen him doing that before.”

Kostka agrees: “Guys don’t want to be seen talking to them in a lot of cases. That might be a bit of a generalization, but there is a fear of being seen. Okay, if there is a sports psychologist or mental performance consultant or a psychologist, everything might be confidential, but if the coach sees you walk into an office and talking to them, [players] might be concerned of how that could influence a coach’s decision.”

In situations like that, both Kostka and Meisner note the confidential, third-party aspect of CCMHS could prove beneficial and allay concerns of wary athletes. After Meisner’s article was published, he received about 60 emails from hockey players ranging from ages 12 to 30. A common theme he recognized was silence. It’s difficult for an athlete to admit they are having trouble focusing or staying motivated or getting out of bed in the morning when the teammate in the next stall is playing through a partially torn muscle, an ankle sprain or a bum shoulder. And that’s not just a problem limited to hockey. “People don’t like to admit weakness,” says Angus Mugford, vice president of high performance for the Toronto Blue Jays. “Especially when it’s in their mind. It’s much easier for some people when they can point to a broken leg or something physically wrong — it’s easily accepted. When people label mental toughness to gritting your teeth and sucking it up, that’s not healthy.”

"THE FUEL BEHIND ALL OF THIS"

Keana, centre, with Durand-Bush and Van Slingerland at the centre's opening event in 2018

Kevin Rempel was on top of the world when he returned home from Sochi, Russia, following the 2014 Paralympic Winter Games. He’d brought home a bronze medal as a member of the Canadian sledge hockey team; he was in the best shape of his life; he had made several real estate investments and bought a brand-new truck and Harley. “But I found myself empty and over the next couple of months, started to feel very, very depressed,” Rempel says.

He was suffering from post-Olympic depression (also known as post-Olympic blues), which is common among athletes returning from the Games. After devoting themselves with tunnel vision for four-plus years, many athletes arrive home and feel lonely or purposeless. The mere act of getting out of bed can be difficult and feelings of excitement and anticipation are missing as the they try to reintegrate into “normal life.”

By the summer, Rempel had blown through his savings and hit rock bottom, prompting his mother and grandmother to take him to the emergency psychiatric ward at St. Joseph’s Hospital in Hamilton, Ont. It was around 1 a.m. when Rempel was led into a room to see a doctor. There was one other patient waiting to be seen — a teenager with around a dozen fresh cuts on each forearm. “We’re in the room for 60 seconds when I hear this kid, on the other side of the wall, screaming and yelling, ‘F— you. You told me you weren’t going to make me talk about this.’”

The teenager kicked the door open and punched a hand sanitizer dispenser off the wall, before security arrived to calm him down. The doctor stood in the hallway for a moment and then walked into the room where Rempel and his family were waiting. “He says, ‘Okay Kevin, let’s chat,’” recalls Rempel. “From that moment, I feel like mentally, I was fixed. What happened in that moment was that I knew that I’m not as bad as [the teenager] was, in the sense that I knew what I did, or the things that I’ve done to create my problem and allow this depression to happen. I knew how and where I was responsible to turn things around. I needed to get better so I could help people like him.”

Rempel has since become an author, motivational speaker and sledge hockey and mental health advocate. He is also one of the original stakeholders at CCMHS, providing continued input and feedback from the perspective of a national team athlete who battled mental health issues.

The link between Team Canada and CCMHS is strong — members comprise 34 per cent of active or completed clients at the centre. The stressors that can plague athletes as they prepare for international competition are varied, ranging from isolation — due to long stretches training far from home — to body image issues and weight restrictions.

The fear that Meisner and Kostka refer to about seeking help within one’s own organization is also felt among national team members, some of whom have paid out of their own pockets to receive treatment at CCMHS, according to DesClouds. The centre works closely with organizations linked to the Canadian Olympic Committee (COC) and other sports institutions across the country, but stays at arm’s length to maintain trust and confidentiality. “Nobody in their sport will know unless they want us to bring [their organization] in,” Durand-Bush says. “That’s what’s helping establish us as a different mechanism for them to get help. Within all our national teams, you have what they call ‘integrated support teams’ that are there for their athletes. Within those teams, you will find practitioners like myself — mental performance consultants. More and more, we’re seeing psychologists [and psychiatrists]. That is awesome, but there are still athletes who are choosing not to work with these people, for fear of this information getting back to the coach, who has all the power.”

Thomas Hall is a national manager at Game Plan, a wellness program for national team athletes that’s a collaboration between the COC, Canadian Paralympic Committee, Sport Canada and Canadian Olympic and Paralympic Sport Institute Network. He agrees that there are instances where national team athletes don’t want their coaches to find out they are seeking help. In those cases, Hall says the Game Plan team will ensure them help and that no information will be revealed. Yet still, sometimes an athlete just doesn’t want to take the chance.

“There are still athletes choosing not to work with team psychologists and psychiatrists for fear of this information getting back to the coach, who has all the power.”

Hall, himself a former Olympian who won bronze in canoeing at the 2008 Beijing Games, understands the situation all too well. “From the athlete’s perspective, it’s, ‘Who’s having dinner together?’” Hall says. “If I’m on tour, I’m in Europe and I’m hungry, and I see the psychologist is having dinner with the coach and that coach and I are really not getting along and I’m suffering stress about that and they are drinking wine together and laughing, then I’m going to maybe not trust that [psychologist]. And that has nothing to do with whether or not they would tell the truth. It’s just perception.

“For us, it’s essential that there are third-party options out there.”

Hall speaks with Van Slingerland weekly and says the centre plays an important role in filling gaps. Game Plan services a roster of roughly 3,000 current and former national team athletes. However, they typically only work with athletes who have retired within the past two years. CCMHS is also solely focused on mental health, whereas Game Plan covers much broader ground, from mental health to career development to lessons in how to do your taxes. If a national team athlete chooses to stay in-house and receive help from Game Plan, there is no cost to them.

“The CCMHS is part of the sport ecosystem that supports athlete mental health,” says Hall. “We work with them and other organizations to make sure we don’t duplicate services and that athletes know they’re an option.”

WHENEVER, WHEREVER

Though the centre is based at the House of Sport in Ottawa, it has staff spread across the country. Patients can also be seen remotely.

When CCMHS held a one-year anniversary fundraiser at the House of Sport in late 2019, it was easy to pack the place — there is widespread support for what the centre is doing. When Van Slingerland or Durand-Bush have a general conversation with a care team member about the breakthrough of a client, there is validation.

There is also buy-in from some coaches, which is an essential step toward altering the stigma of mental health in sport. “Coaches need to know where they can get the support to support the athletes,” says Andy Sparks, head coach of the UOttawa women’s basketball team and a CCMHS board member. “If there’s avoidance behavior [from a coach], it doesn’t get to the level that it needs to [in order] to get that person back to good mental health as quickly as possible.”

Despite the support, though, CCMHS still faces issues. Funding remains a major concern. Everyone at the centre is essentially working a side hustle. There is no full-time staff. Given there are already gaps in the Canadian healthcare system’s funding of mental health initiatives for the general population, it’s unreasonable to expect the government to provide more for the specialized population of athletes and coaches. But in late April, CCMHS did receive charitable status, which could entice more potential sponsors and donors.

To Durand-Bush the CCMHS has been worth the copious amounts of time and effort she has poured into her dream. “We are seeing success because we’re at the table,” she declares. “We’re at the table within many projects, many conversations about mental health and sport in Canada. People are asking us to take part and we have to say, ‘No,’ because we have too many requests. We’re being asked to develop webinars and workshops for parents, coaches, athletes. We are asked to present at conferences.

“Our clients coming through the centre are satisfied,” she adds. “That, to me, is saying this is working.”

About a year before Van Slingerland scrawled her suicide note in crayon, she visited the health centre at Carleton. She was wearing sweatpants that day — she pretty much lived in them during her second year in university. She was set to meet with a campus counsellor and as she walked in, she felt hope that somebody would finally listen to the problems she was facing on her basketball squad. This was the first time she reached out for help.

The response she got floored her. “Why don’t you quit basketball? It seems like a huge stress in your life,” the counsellor told her. That conclusion was simply unfathomable. Basketball had been everything to her for nearly two decades — more important than school. No way was she going to leave. She worked so hard and invested so much time to get to where she was. And besides, she was not a quitter. Van Slingerland walked out that day and never returned to the health centre. She was confused and felt that she didn’t deserve help. Her life slowly spiraled into a dark place.

The experience deeply informed Van Slingerland’s work and what she is carrying out with the CCMHS. In her work at the centre, she has heard several athletes recount variations of the same story. There was the time a young, high-level athlete sought help at CCMHS. This athlete had been through the mental health system extensively. She had seen a psychiatrist, a psychologist; she had engaged in self-harm and had been in and out of hospitals.

At one point during her session with a CCMHS team member, though, she turned to her mother and said, “This is the best session I’ve ever had with a practitioner. She gets it.”

Van Slingerland deems it the centre’s biggest success story. “That feeling of being understood, finally,” says Van Slingerland. “Somebody with all these clinical issues who really just needed to talk to somebody about sport — somebody who got it.”

That young girl has progressed considerably. She is still a client with the CCMHS and she is doing well in her sport.